ROBERT B CLARK JR MD LLC
NPI 1326079039
Specialist in Vidalia, GA

Q: What is Robert B Clark Jr MD LLC's NPI number?

The NPI number for Robert B Clark Jr MD LLC is 1326079039. It was assigned to this organization in the NPPES registry on July 5, 2006.

Q: What is Robert B Clark Jr MD LLC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Active since July 05, 2006

1811 MANNING DRIVE, VIDALIA, GA 30474(912) 537-6634(912) 537-1909 Get Directions Write a Review

NPPES record last updated: March 27, 2013. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Robert B Clark Jr Md Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ROBERT B CLARK JR MD LLC (NPI 1326079039) is a healthcare organization registered as a specialist in Vidalia, Georgia and active in the NPI registry since July 2006. The organization lists Priscilla E Edge, Credentialing, as its authorized official.

NPPES Registry Identity

NPI1326079039

Entity TypeOrganization

Primary Taxonomy174400000X

Legal Business NameROBERT B CLARK JR MD LLC

Location Address1811 MANNING DRIVEVidalia, GA 30474

Mailing Address1811 Manning DriveVidalia, GA 30474 · (912) 537-6634 · Fax (912) 537-1909

Phone(912) 537-6634

Fax(912) 537-1909

Organization SubpartNo

Authorized OfficialPriscilla E EdgeCredentialing · (912) 537-8691

Enumeration DateJuly 5, 2006

Last NPPES UpdateMarch 27, 2013

✔ NPI 1326079039 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers

Taxonomy Code174400000X

License✔ Licensed in GA · 020521

Definition

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

1811 MANNING DRIVE, Vidalia, GA 30474

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Other Identifiers 4

OtherGRP7739GA · Medicare Group Number

Other449866340GA · Medicaid Referral

Medicaid000177713DGA

Other1144289349GU · Personal Npi Number 1144289349

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Robert B Clark Jr MD LLC's NPI number?

The NPI number for Robert B Clark Jr MD LLC is 1326079039. It was assigned to this organization in the NPPES registry on July 5, 2006.

Where is Robert B Clark Jr MD LLC located?

Robert B Clark Jr MD LLC is located at 1811 Manning Drive, Vidalia, GA 30474. The listed phone number is (912) 537-6634.

What is Robert B Clark Jr MD LLC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

When was this NPI record last updated?

The NPPES record for Robert B Clark Jr MD LLC was last updated on March 27, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.